When I trained as a medical student I was very disappointed in the course. I was excited by the discovery of the structure of DNA, by the interaction of actin and myosin in muscle and by the articles appearing in Scientific American every month about the new science of molecular biology. But the course at my University seemed not to have changed from the 1930s when the professors were students. We spent hours cutting up dead bodies. We killed frogs and experimented on their leg muscles using smoked drums to record the responses. We watched demonstrators kill rabbits and snatch their still beating hearts from them so that we could perfuse various chemicals through them. We were given bits of rat uterus to suspend in beakers of salt water while we dropped hormones on them. When we eventually visited the wards we were shown endless cases of rheumatic heart disease, or men who had a heart attack weeks ago, lying still and sedated while their hearts ‘rested’. There were lots of women with fractured hips lying in bed wearing Thompson’s splints until they healed, or more likely died form urinary infections or pulmonary embolus.
The wards were long ‘Nightingale’ rooms with solid fuel stoves at one end. The beds were rigidly marshaled with every sheet straight patrolled by nurses in ridiculous hats who were supervised by sisters who with menacing eye ensured that every stocking seem was also straight. As medical students we were forbidden to talk to the nurses; it seemed our only role was to take blood samples from patients using heavy glass syringes that had to be sterilized between patients and steel needles that must be sharpened and boiled between venepunctures. Fortunately, blood tests were seldom requested.
In the operating theatre the consultant surgeons were treated like gods as they performed operation named after famous practitioners – Halstead, Bilroth and Patey, I remember. In fact almost everything was named after some doctor, diseases, operations, surgical instruments, even the wards themselves. Despite their eminence, we seldom saw the ‘gods’. Presumably they were doing their private practice somewhere. The hospitals were run by the Senior Registrars, very competent men in their early forties who were waiting for dead men’s shoes.
As far as hematology was concerned we learned that there were 4 blood groups, A, B, O and AB, and that iron and B12 deficiency were important causes of anemia. I never saw a patient with leukemia and the only cancers we saw were treated surgically. It was commonplace when disseminated cancer was found at operation that the patient was kept unconscious until he died. Patients were never told they had cancer; euphemisms like ‘neoplasm’ or ‘mitotic lesion’ were used. Indeed patients weren’t even treated like people. They were teaching material. They were discussed from the end of the bed in the third person singular and if they interrupted they were told, “This doesn’t concern you.”
As students we were instructed as much on how to present ourselves as about medicine. Make sure you wear a clean shirt that your trousers have a sharp crease, that your shoes are polished, your hair short and your fingernails clean. After qualification you suddenly found responsibility and realized that you knew nothing. It was then that I began to meet people who were interested in the science of medicine. They were unpopular with the ‘gods’ because they questioned authority. They wanted evidence for doing things this way, and ‘we have always done things this way’ was not evidence. They were unpopular with the hospital administrators because the old ways were cheap and the new ways more expensive.
I began an intensive course of finding things out for myself. I found the textbooks to be largely useless. When I finally settled on hematology I had to describe things from my own observations down the microscope. It was necessary to get rid of the old men’s names. Who cared about Di Guglielmo or Helen Wills? There were diseases out there that were very common that nobody knew about. A textbook of Immunology stated boldly that nobody knew what lymphocytes did, but one thing could be certain: they were nothing to do with the immune response. My professor taught, from his experience with rats, that they were the precursors of red cells.
When I was appointed to Bournemouth there were three consultant physicians; now there are over thirty. I was the first haematologist and I doubled up as the first medical oncologist. There are now seven individuals doing these jobs. We used to deal with 80 blood counts a day; now they have more than 800.
We were advised to retire at 60, because if we waited until 65 we could expect less than 2 years of retirement – and we were lucky, average life expectancy for men was 64 and for women 68.
I write these things to give a flavour of how far we have come. If you look at the graphs of yesterday’s post you may be surprised at the rapid increase in expenditure. Don’t be. We can do much more than we used to be able to and we have the results to prove it.
4 comments:
Once again your Blog has stirred my memories, indeed I was at 14, one of those patients lying to attention in a Glasgow Nightingale ward in 1941. I had seen the Specialist Doctor on the Wednesday and here I was on the Thursday, lying petrified waiting for an Appendectomy. When I espied a woman wearing a hat that would have done justice to a “Man of War” under full sail. She did not walk, but sailed down the ward, I noticed quietness descend, as she came ever closer to my bed. She stopped and said have you been shaved boy, I hesitated what did she mean I didn’t shave. Without more ado, she whipped back my covers, undid my pyjamas and taking my manhood between fore finger and thumb, turned it one way then the other and announced you have not been shaved boy. She turned on her heel and sailed back up the ward and presumably berthed herself.
I was still trying to compose myself, my red face was subsiding when a young neophyte nurse arrived with a basin of water, soap, towel and razor. She proceeded to put screens round my bed when she finished, seeing my questioning look she said, yes I have to shave you. My blush returned right then, I am sure her face was in the same state. She informed me that the sailing ship lady was, The Matron.
My innocence was gone, perhaps today she would be called a pedophile, she touched me after all, without a by your leave. The other point I learned, initially I was well down the ward in the inbox area, as I got better, my bed position changed, to nearer the ward entrance. That was fine, but the very ill were also moved nearer the entrance, however the difference was when they got the curtains. I guess that is where that phrase came from.
My next recollection was the Chloroform, I remember the mask over the face, the whirling sensation. I fought off the anesthetist and heard the surgeon tell him”now don’t let that happen again” then nothing, until wakening as sick as a dog, but nearer the ward entrance.
The next episode in my stay at the Glasgow Royal Infirmary was to hear the air raid sirens sound. Suddenly there were nurses running around handing out enameled basins. One had to put them over their heads to protect from flying shrapnel. It was 1941and WW11 was in full swing.
The last part of the story of my appendectomy; after returning home, I was visited by the District Nurse who would change my dressing and cut off an inch or so of drain tube. When the tube was finally extracted she would use bluestone on the proud flesh, it would sting the wound and bring tears to the eyes, but it shrunk the proud flesh. Maybe it would shrink nodes too.
My mother-in-law was one of your sisters with "a menacing eye" and
ruled her home somewhat like a hospital ward. She moderated somewhat in later life and I used to enjoy visiting her in Sway, on the edge of the New Forest. She would certainly have taken issue with your earlier blog about the lack of snakes in the New Forest.
She often warned me about the adders in summer.
She worked at St. Mary's in Paddington. She had a collecting box in her ward and all the visiting doctors/consultants were required to contribute. She took pride in recalling that she even managed to get a contribution Alexander Fleming who was apparently a regular visitor.
I have just spent a few in days in Hospital with pneumonia. I was in the new Clinical Haematology building in Nottingham.
The facilities for infection control reminded my wife of her training as a nurse in a Berlin hospital. As a junior nurse she had to follow the Consultant on his ward round holding a basin of disinfectant so that he could clean his hands between patients. In my ward all the beds are in single rooms with their own bathrooms. In the corridor outside there was a alcohol dispenser. Then there was a vestibule for each pair of rooms with washbasins for the medical staff to use before entering the patient's room. There was a separate washbasin for each room! From the corridor to my room there were four alcohol dispensers.
The bottom line is that since moving into the the new block the length of stay for transplant patients has shortened significantly as there are fewer infections.
My doctor has told me in the past that Nottingham's results on transplants compare well with other centres. For anyone considering a transplant, and I exclude Terry who I recall said that the best thing about reaching 60 was that he no longer qualified for a transplant, they need to consider not only the competence and experience of the medical staff but also the quality of the building.
And the buildings alongside. During one year we had 17 cases of systemic aspergillosis, costing hundreds of thousands of pounds in liposomal aphoterecin. It was caused by building worj next door dixturbing fungal spores from the soil. We solved the problem by putting Hepa filtration in to protect our transplant ward.
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